Teresa Y Bolt, LPCC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

E.0900362SUPV Issued in OH

Practice address

5982 Rhodes Rd
Kent, OH 44240-8100

Phone

(330) 676-8000

NPI assigned

Jan 25, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Teresa Y Gray Former name

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: firstcapitalrecoveryandcounselingllc.teresagray@157487.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coleman Professional Services, Inc.

  • Mental Health Counselor
  • Kent, OH
  • NPI 1982637633

  Professional

  Medicare reassignment NPD
• First Capital Recovery and Counseling, LLC

  • Professional Counselor
  • Chillicothe, OH
  • NPI 1902479587
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1881999647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 SUNBURY RD",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456013062",
            "telephone_number": "740-637-9768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5982 RHODES RD",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442408100",
            "telephone_number": "330-676-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 US Route 22 NW",
            "address_purpose": "LOCATION",
            "city": "Washington Court House",
            "state": "OH",
            "postal_code": "43160",
            "country_code": "US",
            "telephone_number": "740-335-7282 x131",
            "fax_number": "740-335-6802",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "242 E Main St",
            "address_purpose": "LOCATION",
            "city": "Chillicothe",
            "state": "OH",
            "postal_code": "456013414",
            "country_code": "US",
            "telephone_number": "740-773-3272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLT",
        "first_name": "TERESA",
        "middle_name": "Y",
        "credential": "LPCC-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-25",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.0900362SUPV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0301050",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERESA",
            "last_name": "GRAY",
            "middle_name": "Y",
            "credential": "LPCC-S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Kent, OH
• Providers in Kent, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.